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Address
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9 P1~outh Road J~dlF~mCU7 Location 221 Fo11enF.oad
Service No.'8"1 ?31
Kind of Pipe Size Size of Main
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DATE-=-:-•
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TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
WATER DIVISIO~
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The undersigned applies for a supply of water at No.y)'/1 St.and hereb;'agrees to
comply \,ith the rules and regulations as now,or at any future time,established by the Board of Selectmen,
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,K"-;....-"Arn't.of Estimate $~0 'Owner
Arn't.Paid S _Address
Builder _
Sketch of Service Here •
Connection rna
Remarks:
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